Education

Article information
Title: Combating Burnout Amongst Residents Through Fostering Resilience: A Systematic Review
PubMed ID: 40155325
First Author Last Name: Tan

Abstract:
Background:
Burnout, marked by emotional exhaustion, depersonalization and depletion of professional efficacy, is rampant among residents. With deleterious effects on productivity, conduct and patient care, resident programs have increasingly emphasized resilience training to combat burnout. However, the personalized nature of burnout complicates the effective design of such programs. Premised on recent works that identify burnout as a result of shifting personhood, this study utilizes the Ring Theory of Personhood to guide the conceptualization of resilience training programs that address changes in the belief systems shaping one's self-concept.

Methods:
A systematic scoping review to explore how resilience is addressed and assessed amongst medical residents was conducted. Guided by the PRISMA-compliant Systematic Evidence-Based Approach (SEBA), searches for relevant articles published between 1st January 2000 and 4th November 2024 on PubMed, Embase, Scopus, ERIC and PsycINFO were performed. The SEBA methodology facilitated the integration of the themes and categories identified using thematic and content analyses.

Results:
Of 15 953 abstracts screened, 666 articles were reviewed and 69 full-text articles were included. Three domains were identified: guiding theories; methods of teaching resilience; and assessment.

Conclusion:
The reliance on individual or societal theories has constrained the understanding, design and assessment of resilience programs. Current approaches, including mindfulness workshops, self-care initiatives and organization-led resilience training, are neither timely nor focused on the needs of each resident. To mitigate burnout, personalized, longitudinal and timely support is essential. Mentoring offers a more suitable alternative, providing culturally sensitive, resource-appropriate, sustainable and clinically relevant support to build resilience effectively.

Annotation

The finding:
The authors note propose that minimal headway in understanding and mitigating burnout is a result of omitting attention to the individual innate beliefs of physicians/residents, and relational concerns as described in the Ring Theory of Personhood (RtoP). They propose that interventions that focus on a person’s self-concept of personhood and their individual needs are more likely to be successful.

Strength and weaknesses:
The authors use an established conceptual model of personhood as a frame for understanding what aspects of personhood have been studied/addressed in the existing literature. They use a PRISMA compliant methodology for their review and include 24 years of literature in their search. The research questions are well defined and draw reasonable conclusions in their discussion about existing gaps in study and intervention of burnout. Weaknesses include a focus on physicians in the United States and thus results may not be generalizable across the globe. The authors also recognize that limitations of self-report in the existing literature can fail to account for dynamic and evolving concepts and culture that may influence burnout.

Relevance:
CL Psychiatrists are often exposed to intense system pressures and moral injury (e.g. inability to provide safe housing or access to outpatient care for people with chronic, disabling mental illness). It is critical to combat burnout from these pressures and prepare trainees to sustain themselves over time as they enter their own careers beyond training. A more complete approach to understanding burnout that includes personal spiritual beliefs and relational aspects of work life may be more successful than current, less personalized and less longitudinal interventions.